尿钠与尿肌酐比值降低可识别小儿急性胃肠炎中的钠缺乏。

Decreased Urinary Sodium-to-urinary Creatinine Ratio Identifies Sodium Depletion in Pediatric Acute Gastroenteritis.

作者信息

Heinz-Erian P, Akdar Z, Haerter B, Waldegger S, Giner T, Scholl-Bürgi S, Mueller T

机构信息

Department Pediatrics I, Medical University, Innsbruck, Austria.

Pediatric Surgery, Medical University, Innsbruck, Austria.

出版信息

Klin Padiatr. 2016 Jan;228(1):24-8. doi: 10.1055/s-0035-1559689. Epub 2015 Sep 10.

DOI:10.1055/s-0035-1559689

PMID:26356318

Abstract

UNLABELLED

In acute gastroenteritis (AG) fecal losses may cause depletion of sodium (NaD) which may not be recognized because of normal plasma Na (pNa) concentrations. We studied the incidence of this state of normonatremic sodium depletion (NNaD) and the suitability of the urinary Na/urinary creatinine ratio (uNa/uCr) for diagnosing NNaD.

PATIENTS

16 AG- and 16 healthy control children aged 0.8-15.0 years.

METHODS

Prospective cross sectional pilot study. Measurements of Na, K and creatinine in plasma (p) and urine (u). Calculation of uNa/uCr Ratio, fractional excretion of Na (FENa) and uNa/uK ratio as the hitherto best known parameters of prerenal Na depletion, respectively.

RESULTS

pNa concentrations were normal in 15/16 AG patients (93.8%) with only one subnormal value of 133 mmol/L, and a mean value of 137.9±2.3 mmol/L not different from the normal control group (139.4±2.2 mmol/L). Also, mean uNa concentrations and uNa/uK ratios did not differ between both groups. However, uNa/uCr ratios were below normal in 13/16 AG children (81.3%) but normal in all healthy controls with a significantly lower mean value in the AG group (12.6±8.8 vs. 31.2±8.3 mmol/mmol; p<0.0001). Similarly, 14/16 AG patients (87.5%) had a decreased FENa<0.5% with a mean FENa value significantly lower than in controls (0.36±0.28% vs. 0.95±0.26%, p<0.0001). The good agreement between FENa and uNa/uCr results was also reflected by a high correlation coefficient of r=0.9333.

CONCLUSIONS

The majority of AG patients was found to have NNaD as determined by uNa/uCr and FENa. Calculation of uNa/uCr may be useful for diagnosing NNaD in AG.

摘要

未标注

在急性肠胃炎（AG）中，粪便丢失可能导致钠耗竭（NaD），但由于血浆钠（pNa）浓度正常，这种情况可能未被识别。我们研究了这种正常血钠性钠耗竭（NNaD）状态的发生率以及尿钠/尿肌酐比值（uNa/uCr）对诊断NNaD的适用性。

患者

16名年龄在0.8 - 15.0岁的急性肠胃炎患儿和16名健康对照儿童。

方法

前瞻性横断面试点研究。测量血浆（p）和尿液（u）中的钠、钾和肌酐。分别计算uNa/uCr比值、钠分数排泄（FENa）和uNa/uK比值，作为肾前性钠耗竭迄今最知名的参数。

结果

16例急性肠胃炎患者中有15例（93.8%）的pNa浓度正常，仅1例低于正常范围，为133 mmol/L，平均值为137.9±2.3 mmol/L，与正常对照组（139.4±2.2 mmol/L）无差异。此外，两组的平均尿钠浓度和uNa/uK比值也无差异。然而，16例急性肠胃炎患儿中有13例（81.3%）的uNa/uCr比值低于正常范围，而所有健康对照的该比值均正常，急性肠胃炎组的平均值显著更低（12.6±8.8 vs. 31.2±8.3 mmol/mmol；p<0.0001）。同样，16例急性肠胃炎患者中有14例（87.5%）的FENa降低<0.5%，其平均FENa值显著低于对照组（0.36±0.28% vs. 0.95±0.26%，p<0.0001）。FENa和uNa/uCr结果之间的良好一致性也通过高相关系数r = 0.9333体现。